# BRAZOSPORT REGIONAL PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRAZOSPORT REGIONAL PHYSICIAN SERVICES
- **Other names:** Brazosport Regional Urgent Care Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1861795197
- **Legal business name:** BRAZOSPORT REGIONAL PHYSICIAN SERVICES
- **Authorized official:** MR. DANIEL BUCHE (CHEIF EXECUTIVE OFFICER)
- **Authorized official phone:** (979) 285-1105

## Contact information

- **Practice address:** 508 THIS WAY ST, LAKE JACKSON, TX 77566-5128
- **Practice address phone:** (979) 480-9467
- **Mailing address:** 100 MEDICAL DR, LAKE JACKSON, TX 77566-5674
- **Mailing address phone:** (979) 285-1105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | TX | — |

## Other

- **Enumeration date:** 12/08/2010
- **Last updated:** 01/03/2011